Provider Demographics
NPI:1073752994
Name:STORY, STEPHEN BARKER (DPT)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:BARKER
Last Name:STORY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S 20TH ST
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-7100
Mailing Address - Country:US
Mailing Address - Phone:270-408-1324
Mailing Address - Fax:
Practice Address - Street 1:125 S 20TH ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7100
Practice Address - Country:US
Practice Address - Phone:270-408-1324
Practice Address - Fax:270-408-1325
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003779174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5031801Medicare PIN